HomeMy WebLinkAbout18659-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19235 Date JULY 24, 1990
THIS CERTIFIES that the building REPAIR
Location of Property 845 ORCHARD ST. ORIENT
House No. Street Hamlet
County Tax Map No. 1000 Section 025 Block 002 Lot 17.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated—NOV. 15, 1989 pursuant to which
Building Permit No. 18659Z dated NOV. 21, 1989
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is REPAIR EXISTING ONE FAMILY DWELLING DAMAGED BY FIRE.
The certificate is issued to WILLIAM L. WYSOCKI JR.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N127779 MAY 10, 1990
PLUMBERS CERTIFICATION DATED KING PLUMBING & HEATING APRIL 9, 1990
'Building Inspector
Rev. 1/81
vosai xo. a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N O g G J~ Z Date l1l f~'~:~""'!~.... 19 8
Permission is hereby granteyyd~~to:
.l.......... o......~~:.....~.
ra...d~~tatnw~..........~~~~t......~3:!:4:t...~......anr~.~...~.4~-?,Q~;!zA.'...
of premises located at ...~~.~........Q..f~................~
:......:.....~?...y..~........-...........................................................................
County Tox Map No. 1000 Sectionl......p.zS....... Block .....~.~":.......pLot No.........:..~~...........
pursuant to application doted ....N.PF:u~.:'.'!:?.!~r.....~.>~ 19..1., and approved by the
Building Inspector.
Fee $...1..9s~.,~~..
Building Inspector
Rev. 6/30/80
2 5/ ~D APPLICANT ~ ' , _ _ - _ ~ _
Form No. 6
C r
ggp TOWN OF SOUTHOLD ®'
UU lD BUILDING DEPARTMENT D !"-
TOWN HALL
BLDG. DEPT. 765-1802
'TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept.- of water supply and sewerage-disposal(S-9 form) .
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features. '
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . . . . ./ /9 . . . . . . .. . ... ...... .. . .
New Construction. .. .. .. .c.� Old Or Pre-existing Building .� .
Location of Property. .. L : .. .. . . . .O MS:���'.6`..1�. . .,4 .�'E jff T- . • . P R j E IJ 7—
House No. Street • • • Hamlet
Onwer or Owners of Property.. �.t):j�t.sm„ . .l,., .t;� s o c. T"
. . : . . . .. .. . . .. .. .. . . ........ ..
County Tax Map No 1000, Section. . . . . . . . .Block. . .
.sZ. . . .Lot.. / :�. . . . .
Subdivision...... . . . .. . . . . ... ... ... . .. . . .. .. .. .Filed Map. . . . . . . . . . . .Lot. . . . .. .. .... ...... ....
Permit No. �$ sZZ. . .Date Of Permit. .l i��o�.8.9. . . .Applicant./ $. . . , ,� ill/i 0 La7s
Realth Dept. Approval. . . .. . . ... . .. . . .. .. .. . . . . .Underwriters Approval . . . . . . . . . .. ....... .....
Planning Board Approval. . . ..... . ... . . . . . . . . . . . .
Request for: Temporary Certificate. .... . .. . . . Final Certicate.. .v .
Fee Submitted:
A $ .a ........ ...... .
0_ 0 z. ��3Sr_ . . . .sl:.. ..... . .. .
APPLICANT
TEL. 765-1802
~~S~FFOLk~oG TOWN OF SOUTHOLD _ .
ti y< OFFICE OF BUILDING INSPECTOR
c rn P.O. BOX 728
`'O ® SOUTHOLD, N Y 11971 -
~01 ,x,
C E R T I F I C A T I O N
Date 4-9-90
Building Permit No. 186592
Owner Mr. William Wysocki
(please print)
Plumber King Plumbing&Heating Inc.
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
<~'~l(
(plumber's signature)
Sworn to before me this
day of l' ~ C~f]'~ ~ ~ `7~~' E~ v~-
19 d.
No ry Public
Notary Public, County
MARILYN N. NORKELYN
Motary Public, State of NeW Yak c
No. 52-46086b5
Qualified in Suffolk County
Pemrniaaion Eupirsa March 30, 19
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It1SULATIOfi PER N. Y.
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STATE Ef1ERGY
CODE I = +
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ADDITIOfIAL COMMEIITS: x
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THE NEW YORK BOARD OF FIRE UNDERWRITERS ''"t"
1 Ot107J.5
BUREAU OF ELECTRICITY
8S JOHN STREET. NEW YORK, NEW YORK 10038.
MAY 10,1990 (>703139p/9Ct N 7!7774
Doty Application No. on file
THIS CERTIFIES THAT -
onlythe elactricd equipment d dwcri6ed 6eloso and introduced 6y the applicorst nomad on the o6ooe eppliation number in the premises of
W1l1.TAN L WY`i9f,K, OftCHAHU "~'TNta:T, P'Ql!! qt3-I', OftCt:N(, N.Y, ~ -
in thefollotoinR loco nt ~ IAt FI. ~ Pnd FI. A 1 'i) (0 U 7 Section Block Lot
f,'~R''ll ~~84°1ff1'f
coos examined on andfoundro6e in compliance with she reyuirernentx of this Booed.
RXTUEE ACtilS SWpCNES RXTURES RANOES COOKtN6 RECES OVENS DISH WASHERS EXHAUST FANS
OUTIETS INCANDESCENT FlUGI1ESCENT OTNEP MIT. K. W. AMT. K. W. AMi. K.W. MIT.. K. W. AMT. N. P.
311 '71 32 31 1.?
DRYERS WRNACE MOTORS FUTURE AFFUANCE REDEES SPECIAL R[C'FT TMIE CLOCKS ~ UNIT HEATERS MUL740UilET dMIAERS
AMC K. W. ql N. P. GAS M. P. AMT. PIO. A. W. G. AMT. AMI. AMT. AMPS. TERNS. AMT. - N. P. SYSTEMS AMT. WATTS
NO.OF RET
1 j' 1, fill!! -
SlRVICE DISCONNECT NO.OF S E R V I C E _
AM/. ARV. TYPE ~t/ 1 / tVI i / ]\V 1 d SW 3 X IW ~ER eCONU. OF CC. CGND. GF NIAEG NO. OF NEUTRALS Oi "t~G~l
1 1 Uf) (:8 1 X 1 ?
>R
- OTHER AFFAEATUS:
CtIMP{.I:.TC Kf".WtN1NG AfIP.K PCKt:
PANCLN.OARp$:1-ft f.IR. 1041
"~MUKt ftf".ItC10R:-1
/J,~ / i
AR'fFdJK A. RUHUPa)1:: LCC.1k2.Sd6.-t: G/~~~
MAIN KOAO Ii
- I)N[t:Nl. NY, l1.')'i! WFtERAnQI MIWABBt
7 3 G~
Per
This csrtificaM must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be idsMHisd by tFNdr cndentiak.
1 COPY FOR BUILDING DEPARTMENT. TFIIS COPY of CERTIFIGTE MUST NOT 8E ALTERED IN ANY MANNER.
.t _ nf,,_.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE ~
8D18681
®UREAU OF ELEGTRICfTY -
JUNE 2T, 1990 33 JOHN STREET, NEW YORK. N15967382%8238 A 016740
Date Am/tcptjpn.Na. eti~~5
THIS CERTIFIES THAT PF.fClll~f flO s
only the eleetrled equipment a deecrihed beloro and introduced by the epplicont named on the above application number in the premises of
AILLIAN G. WYSOCRI, MAIN ROAD, POLE t40T, ORIENT, N.Y.
'i^"- r7G.~ ~g GAR
in the folloluinE krco tg' nt Cl /et FL ? Ynd Fl. .Section B/ork Lot
was examined on endJound to he in cornpliencr with the reyuirementx of thin Board.
NXTURE RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST TANS
OUTLETS AgEf EWITOIlS NGNDESCFNT FLUg1E5CENi OTHER AM1. K. W. NAT. K. W. AMf. K.W. AMT. K. W. AMT. P.
as so aT as i l.a
DRYERS RMNACR MOTORS IUTURE ANRIANCE RIDERS SMK:IAI REC?T TNM CLOCKS pLL UNIT NEATpS MULTI.OUTIEi REAMERS
AMT. K. W. pl K P. OAS M, t. AMT. NO. A. W. G. AMT. AML. AMT. AMPS. TRANS. NAT. M.I. SYSTEMS AMT. WATTS
NO.OF RET
3 Y
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMT. AMP. TYIE 1 J xW 1 F 7W ] 13W 7 / AW ~RCpCONe. OF CC
. G. NO. OF ~HtG of ~ HI ~O, q NEUTKALS os ~~EiITGN,SI
1 2D0 CB X 1 2/0 .1 210
OTNE11 AMARATUS:
>i
.Na'(
WILLIAM G~' AYSOCRI
MAIN ROAD
ORIENT NY, 11957 oRIEEeAt MANAOM
11 i ~
Per , ~ ~
Thi: nrtificaN must not be altered in any manlror; rotum to the office of the Board if incorrad. Inspectors may be identified by fMir crodentiDls.
COP11 FOR BWLDNIG DEPARTM®!T. THIS IGTE ANKT NOT SE ALTERED IN ANY MAMiER.
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST ( ] R UGH PLBG.
[ ) FOUNDATION 2ND [ INSULATION
[)FRAMING [ ]FINAL
REMARKS: ~
DATE ~ / INSPECTOR"/ ~
i
/ 765-1802
G 0 (P BUILDING DEPT.
INSPECTIQN
[ ]FOUNDATION iST (~OUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL /
REMARKS:
DATE ~ INSPECTOR
BOARD OF HEM\LTH
3 SETS OF PL.\NS
FORM NO. 1 SURVEY ~ • • .
TOWN OF SOUTNOLD CttECK .v/. ~$.3 .
BUILDING DEPARTMENT ` ~SE~~I~ ~t~ORM .
' TOWN HALL
SOUTHOLD, N.Y. 11D71 NOTIFY
• TEL.: 765-1802 CALL
,,11 ~ ~ Q MAIL T0: ~UO~ Cn~.~.`
Gxamincd N•~:~':'s. • • • • 19 ~ .1 s
ApprovedN.l~.'Q.'-'.`~. l9 ~q. Permit No.. ~ ~ ~O`~.9 ~
Disapproved a/c D
(Building Inspector) E3L0G. DEPT.
TOWN OF SQUTHOLD
APPLICATION FOR BUILDING PERMIT
DateNovember 1.3, 198~y • •
~~i,
INSTRUCTIONS
~ ~
a. Tltis ap~l~tcation must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work,
e. No building shall be occupied or used in whole or in part for any purpose whatever unfiT a Certificate of Occupancy
shall have been granted by the Building Inspector. ~ „ ~ ~ ~ ~ ~
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Buildin~ernrit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other a is "•ey-s, Ordinances or
Reculations, fpr ,the ,construction of buildings, addi i ns r tern r ns~ yo~ f r~ v 1,,Q r dem ' - rc~d~ described.
The applicaplt,a;~,ees'~o ~tom:plyiwith all applicab7ts~1~~e~u~1~ es 'using code, , and to
admit autho 'z13t3`~`
1"sp etois on•p~iemises and in bttf~Iae~1•f;~S+,t~~3~fYtj~S C~ic~fl
4';, fi' ,r
(Signature of a pli~an or~ a Corp n)
`I4`t f..n.Z ~ t t', bpt -f'G ~ ~~E~
` 1.OQS1 C~~~~~ fir. , fast Marion,i~
, 4: _ , ss (Mailin5;address ofapplicant] 11939 ' •
< a
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
General Contractor
Name of owner of premises William ht • Wyso k • ~t~t'!i ~~R
~t1~~~t~~~,~~~~;~~latest deed)
IC applicant is a corporation, signature of duly authorizgd; $.f't(~reer~~r,it;;s~
(Name and title of cor~or~te officer) ~i~;~~t',`;S`~'y' ~y3tb`3Y4?i~4{(Et;'J
12,988 HI
Builder's License No : .
,,..~ra,
Plumber's License No. .
Electrician's License No . t.f.. , ~ - i
OthcrTradc's License No. • • -
,'~~i , -
1. Location of land on which proposed work wilf~le,.Qone,...;.,,.. . -
845 Orchard St. Orient
House Number Strict. Hamlet -7
County Tax ~\1ap No. 1000 Section • • • • BI'ock Q•~ . , , • , • • , . Lot' !
Subdivision F.ilcd t,fap No. Lot .
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....Singh, ~amliy .
Same
b. Intended use and occupancy
i ,
3. at oC ork (check ~ 'aPPlicable): New. Uuilding Addition Alteration
N urc w which
Repair ..XXXXX3L Removal " Demol'tion Other Work .
(Description)
~ 1OO,b00.00
4. Estimated Cost........., .Fee
(to be paid on Cling this application)
5. If dwelling, number of dwelling units ~ . , Nu bey of dwelling units on each floor .
Ifgaragc.numbcrofcars
6. [f business. commercial or mired occupancy, specify nature and extent of each type oC use .
7. Dimensions of existing structutcs, if any: Fron[ . . ,Rcar Depth , . , .
Height Ntintbcr of Stories , , .
s ~Dimeggidris of same structure fvith alterations or additions: Fr nt . Rcar .
` popth Itcight Number of Stories .
.
$."~Dimensians of entire new construction: Front Rear Depth .
Heigh. Nujnbcr of Stories . .
9. Sizeo ot: Front Rcar.. Depth
10., Date of Purchaso ..................Name of Poimcr Owner .
1 1. Zone or use district in which pxcmises are situated . .
12. Does proposed construction viglate any zoning law, ordinance r regulation: NR • .
r , ~ FlG .
14. Nnmle of Owner of
premises 1~}~ ' ' ' ' ' ' • • • 1ViIl e cess fill be removed from premises: No
1.7,?$m. 1m:Ysoe)ii ..Address . .................Phone No.3?3-„ .
Name of Architect .......'i... , Address ~ :.................Phony, No. .
im zenkowski~ 477=2463' .
_ ........Address .................Phone No.
Name of Contractor . K~,
IS.Is this property loc$ted within X00 feet f a tidal wetland? *YES....NO.xx.
*If yes, Southold Town Trustees PLOTDIAGRA be required.
Locate clearly and distinctly all, buildings, whether existing or proposed, and, indicate all set-back dimensions from
property fines. Give street and block) number or description accordin to decd, and show street names and indicate whether
interior or comer lot.
Fire damage repair, all work o be done within existing ,
frame wa3.7vs, No extentions o~ stru ture past exiatizlg. ,
g~~G ~ RTIfICAT/ N FERMI
SYSTEMS~UDNDER
R*v R CE aRM
Q~`0~A P~UMBE
~t* , p~/ ~.EqD CONTENT BEf RE a~ ALARM u~w
CEf~TtFICATL~ Of OCCUFA CY ; _lr~~: taY ,
$4LD~'R ST
~ CANN T ~ r{ ~~~g' ti,:i~ai
oAr~ .
EX~C~ED 2/703 of 7% LE D. ~
PEE: ' `z? BY Y..~!L. ~I.
NC7TtFY I3tISt..t)lNC7 i1~ t>.:. ~r;'~~s'I ~ ,
I,
i ~ 765 ,.180~'~;~-,,f~t.,5 ~'fi t' a , . , i s
} F~OL~.O1N1f~iCoaN;P6::C~'E~"~'t~,.J~~',cFP
1f>~dUt~ll~A~lt(),tu~iVi.ntTl/b't7 i^tFLttll,~;'
~ 2 .;,)iSPt~ PQtDIRG)N£~~.TFM BING
{f copper tutitrlg is us :a. +$t;~t41t~4IHMt FRAMING Ra ,~s_uMt~INc
for water distributing ~ k'l;T1l~I,SULAT~STRUCTION MUST
ay$t®1Y1: ptAM9 shell be ~ C'~NIBdPI.k:TEG®{~~CfUCTIt7N MUST
of types K or l ont AL1. ttt4NSS~114BGFC1t~h(Ait MEET
TH~U~E~~MI~~FSWp1EL MwE ET
UPIDERWRTtERS CERTIFICAT ~ t3Tdff~ d~t,~TS 8f3rEw.v.
REQUIRED ~ rpg~(E~ sRRWtgl~iel~ EwgRGv
' UE UIaSIGN OR~C~ON$TRUCTlQN~RORS
STATE OF i~E1V YORK, S S p
COUNTY OF OCCUP~ANdC ~R
(Nam1
of~ndivllidunkoniek contract) ~S~ IS UIY~ ~ t porn, deposes and says that he is the applicant
above named. i ~OT~yyj{~T (,~~RT~1f 4CATE
co tractor. ~ <pF:OCCUPJ~NCY
Ilcisthc . d ............c.:..........
~(Cogtractar, agent, corpo ate officer,.ctc.)
~f said owner or owners, and is duly ~;authorizcd to perform or have ~erformed the said work and to make and file this
=pplication; that all statements contairjed in this application arc true ~o the best of his knowledge and belief; and that the
I .vork will be performed in the manner set forth in the application filed herewith.
iworn to before me this
C~~?~t%~~c;~~~C.da of ../i ./•6 ~/>°ir~-~2e;
t= 19
~otaryPublic, 1~.N~aM.. ..:...~tl~.li/r~.~~~... County °b ~
t)REW A. WALKfR ~ . . '
N6TARY PUBLIC, State pt New Yotk 0~~`.. • . • • .
No. 4898779, Suffolk County (Signature of applicant)
Term Expires lanuary,11,19~a